FY19_Attachments.pdf

CAD/PAD Item Marking Instruction, V 1.3

CAD/PAD Item Marking Instruction

Prepared By CAD/PAD Joint Program Office

784CBSG/GJ

Code E25MA, NSWC IHEODTD

Version 1.3 Dated 23 Mar 2017

Table of Contents

1. Purpose Page 4

2. Scope Page 5

3. Marking Requirements Page 6

4. Placement of UID Markings Page 8

5. Items delivered in kit format Page 9

6. Waivers Page 9

References

NOTE: Use latest revision of all reference documents.

1. MIL-STD-130 Department of Defense Standard Practice Identification Marking of U.S.

Military Property

2. MIL- STD-1168 (current revision) Ammunition Lot Numbering and Ammunition Data Card (Note section 3.1 for new lot assignment for “remanufactured CAD/PAD Components”)

3. ISO/IEC 16022 Information technology - International symbology specification - Data Matrix

4. ISO/IEC 15434 Information technology - International symbology specification - Syntax for high capacity ADC media

5. ISO/IEC 15418 Information technology - International symbology specification - EAN/UCC Application Identifiers and FACT Data Identifiers and Maintenance (Note: Data Identifier dictionary with technical content is contained in ANS MH10.8.2)

6. UNDER SECRETARY OF DEFENSE FOR ACQUISITION POLICY AND

TECHNOLOGY Department of Defense Guide to Uniquely Identifying Items version 1.6 (this document is available on line at http://www.acq.osd.mil/dpap/pdi/uid/index.html or from Defense Procurement & Acquisition Policy, 3060 Defense Pentagon, Room 3E1044, Washington, DC 20301-3060)

7. DEFENSE FEDERAL ACQUISITION REGULATION SUPPLEMENT 252.211-7003

Item Identification and Valuation (Copies of this document are available on line at http://farsite.hill.af.mil/ or from the Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954)

8. AFSCM 21-556 Vol. 2 Julian Date format

9. ANS MH10.8.2 - 2006 Data Identifier and Application Identifier Standard

10. ANS MH10.8.7 - 2005 Labeling and Direct Product Marking with Linear Bar Code and Two-Dimensional Symbols

Figures

1. Determining IUID requirement

2. Sample UID Data Stream

3. Sample CAD/PAD Data Plate/Label

4. Sample of Etched Data

5. Sample CAD/PAD Small Item Data Plate/Label

1. Purpose.

The Under Secretary of Defense has implemented policy requiring DoD components meeting the requirements identified in Figure 1 to be marked with Item Unique Identifiers (IUID). Cartridge Actuated Devices and Propellant Actuated Devices (CAD/PAD) items, regardless of dollar value, are typically serially managed in aircraft maintenance data systems and therefore are applicable to the IUID requirement.

Additionally, the Air Force Aircrew Escape System Executive Working Group (AESEWG) and the egress system maintenance community has requested that CAD/PAD items be marked with Data Matrix ECC 200 on item data plates or items to enhance accuracy of aircraft maintenance data.

In accordance with MIL-STD-130, this marking instruction identifies marking requirements that meet the above objectives by tailoring Unique Identification (UID) requirements to include aircraft maintenance data requirements for both free text Human Readable Information (HRI) and Machine Readable Information (MRI), which are both mandated requirements for CAD/PAD items.

Figure 1. Determining UID Requirement

2. SCOPE.

This instruction identifies marking requirements applicable to suppliers/manufacturers of CAD/PAD components. It is applicable to both production of new CAD/PAD components and remanufacture of service returned, over-aged components. It identifies marking methods applicable to the various sizes and shapes of CAD/PAD components.

As of this writing, guidance regarding mandated transfer of data to the IUID registry can be found at “http://www.acq.osd.mil/dpap/pdi/uid/index.html”. Go to Training and Communication link, select IUID Toolkit (www.IUIDtoolkit.com), and select “Defense Suppliers”, then under “Submit”, select subsection “Registration of IUID Data11”, under Support Tools select “Data Submission”.

http://www.iuidtoolkit.com/

3. Marking Requirements.

Both Human Readable Information (HRI) and Machine Readable Information (MRI) are required (see section 4). In accordance with the Defense Federal Acquisition Regulation Supplement (DFARS), DoD has mandated the use of Data Matrix ECC 200 as the standard format for UID MRI markings. Guidance for the construct and application of Data Matrix markings is contained in MIL-STD-130 and the DoD UID Guide located at http://www.acq.osd.mil/dpap/pdi/uid/index.html, select Guides link.

3. 1. HRI Marking Requirements. The following HRI data is required (as a minimum):

- Item Nomenclature; Per applicable manufacturer drawing

- Manufacturer’s Commercial and Government Entity (CAGE); Five (5) alpha/numeric characters.

- Item Lot Number; Lot numbers shall be assigned IAW MIL-STD-1168 (current revision), unless otherwise directed. A new lot number and serial number shall also be assigned for “remanufactured” CAD/PAD components as opposed to adding a suffix to the original lot number for a “rework, overhaul or renovation” effort.

NOTE: The requirement for unique lot number has been deleted.

DOM is NOT required if the lot number contains the DOM as identified in MIL-STD-1168

- Item Serial Number; Six (6) digit serial numbers (minimum) are required. Serial numbers shall be sequentially assigned and shall not be repeated until serial number 999,999 has been reached.

- Item manufacturer’s Part Number

NOTE: The weapon system Specification Number does not meet this requirement

- Optional markings: Additional markings (such as manufacturer’s name, logo, contract number) are acceptable, provided that space is available on the item/data label. Date of Manufacture (DOM); DOM shall be MM/YYYY and be the same date that is coded into the lot number.

NOTE: Markings and/or attachments shall make no reference to item installation requirements/procedures or shelf/service lives http://www.acq.osd.mil/dpap/pdi/uid/index.html

3.2. MRI Data Construct.

Data Matrix ECC200 markings shall be developed based on UID Data Construct #2 using Data Identifiers (DIs) in accordance with MIL-STD-130 and the DoD UID Guide (see Figure 2). To facilitate durability throughout the scanning life cycle, the largest symbol size, including quiet zone, shall be fitted within the available marking real estate. The symbol’s internal module (cell) sizes shall be no smaller than 0.0075 inch (0.19 mm) and no larger than 0.025 inch (0.64 mm). Marks shall contain only the data elements identified below:

NOTE: The actual UII will be comprised of CAGE, Part Number, and Serial Number data. The parenthesis surrounding the Data Identifiers are NOT encoded in the 2D symbol

(17V) Manufacturer’s Commercial and Government Entity (CAGE) code, 5 alpha/numeric characters

- (1P) Manufacturer’s Item Part Number, 18 alpha/numeric characters maximum

NOTE: The weapon system specification numbers do not meet this requirement

- (S) Item Serial Number, IAW HRI requirement, six (6) digits minimum, up to eight (8) alpha/numeric characters maximum

- (30T) Item production Lot Number, IAW HRI requirement, 15 alpha/numeric characters maximum

NOTE: The data identifier for Lot Number has been changed from 1T to 30T

- (4D) Date of Manufacture (DOM), in Julian Date format, five (5) numeric characters:

Example: 08151 = 31 May 2008

The first two positions are the last two digits of the year, the last three positions are the Julian Date (001 through 366)

R

S 06 G

S 17V 12345 G

S 1P 123456789-ABCDEFGH

G

S S 12345678 G

S 30T ABC06D123-001

G

S 4D 08151 R

S E oT

Figure 2. Sample UID Data Stream

4. Placement of UID Marking. CAD/PAD items vary considerably in size and shape. A large percentage of these items are currently marked with HRI printed on data plates or labels permanently affixed to the item. The preferred method for incorporating the UID required MRI is to include it on the current data plate/label and, wherever possible, the supplier is to incorporate this concept. The following identifies known variations in marking and preferred MRI incorporation methods.

Note: Unless specifically identified as a requirement in the procurement contract, subcomponents of the End Item Assembly shall not be UID marked.

4.1. CAD/PAD Items Currently Marked with Data Plates, Labels, or Flag-Tags. The data plates/labels for these items shall be modified/arranged to allow space for the MRI per paragraph 3.2. Marking shall comply with MIL-STD-130 and the DoD UID Guide (see figure 3).

Figure 3. Sample Data Plate/Label

4.2. CAD/PAD Items Currently Marked With Ink or Laser Etching Directly on the Item.

Item marking shall be modified/arranged to allow space for the incorporation of ink or laser etched MRI per paragraph 3.2. Marking shall comply with MIL-STD-130 and the DoD UID Guide (see figure 4).

CAD/PAD Builder Inc.

Acft Explosive Component Noun

CAGE: 12345

P/N: 123456789-1234 Ser No: 0001

Lot No: ABC08D001-001

DOM: 04/2008

Figure 4. Sample of Etched Data

CAD/PAD Builder Inc.

Acft Explosive Component Noun

CAGE: 12345

P/N: 123456789-1234 Ser No: 0001

4.3. CAD/PAD Items Considered to be Too Small for HRI and MRI. These items shall be physically marked using currently approved methods for HRI. A self-adhesive label shall be supplied in the item inner packaging that includes the minimum HRI (per paragraph 3.1) and the MRI Data Matrix marking (per paragraph 3.2). The label shall be as small as possible (meeting MIL-STD-130 requirements for HRI) and will include only the minimum required data (see figure 5).

Figure 5. Sample Small Item Data Plate/Label

Note: This will allow the maintainer to scan the MRI from the label and the ability to affix it to the next higher assembly.

5. Kit Marking Requirements. Individual components procured and delivered in a “kit” or “ship-set” format shall each be marked with HRI and MRI as identified in sections 3 and 4.

The kit containers shall also be marked with HRI and MRI per sections 3 and 4.

Note: Individual components supplied in kits or ship-sets require unique item identifiers. Their markings shall not reflect those identifying the kit or ship-set.

5.1 Only the “kit “or “ship-set” will require data submission into the UID Registry. Data submission for individual components in a kit is not required, as these components were not individually priced as line items when placed on contract.

Note: To meet UID requirements, each kit will be assigned an individual serial number. Kits that are comprised of multiple containers will all be marked with the same serial number.

5.2 “Kits” or “ship sets” will typically be assigned lot numbers coinciding with the oldest individual component in the kit.

6. Waivers. Waivers to the UID requirement are not allowed. Requests for waivers to marking methods outlined in this instruction may be considered. Submit requests through appropriate contracting channels.

Acft Explosive Item Noun

CAGE: 12345

P/N: 123456789-1234 Ser No: 0001

AMMUNITION DATA CARD MASTER Rev 12

12 April 2016

Ammo Card Listing

* * * * AMMUNITION DATA CARD * * * *

NSN 1377009991212 M009 (NSN AND DODIC WITH NO DASHES)

NOMENCLATURE CARTRIDGE IMPULSE, MK 99 MOD 1 (INCLUDE MODEL, SEE SECT B of KT)

LOTNUMBER PQP06A008-001 (PER MIL-STD-1168)

SERIAL NUMBER (ENTER N/A. SERIAL NUMBER INFORMATION WILL BE ENTERED IN REMARKS FIELD)

CONTRACTOR PROVEN QUALITY PRODUCTS, INC

NET QUANTITY 2722 (QTY AVAILABLE TO SHIP AFTER LATS, RETAINS AND REJECTS REMOVED

FROM LOT)

PACKING 1 PER BAG/2 PER FBB/20 MAX PER WOODEN BOX /SPI 01-0633165h (GIVE DETAILS

AND INCLUDE SPI OR PACKAGING DWG NUMBERs)

CONTRACT/ORDER NUM N0010406CK999 (PRIME CONTRACT NUMBER - NO DASHES)

PURCHASE ORDER NUM (SUBCONTRACTOR PURCHASE ORDER NUMBER FROM THE PRIME

CONTRACTOR)

DRAWING NUMBER 951AS111 (USE GOVT DWG #; IF NONE USE KTR ITEM P/N; SEE SECT B OF KT)

* DRAWING TAB

DRAWING REV - (IF NONE PUT “N/A“)

SPEC NUM MIL-C-99999

SPEC REV C

SPEC AMEND 1

DATE STARTED 01/01/2006 (MM/DD/YYYY; MUST MATCH MONTH LETTER IN LOT NUMBER; DATE

PRODUCTION LOADING OR ASSEMBLY STARTED, UNLESS OTHERWISE SPECIFIED BY PRODUCT

ASSEMBLY DRAWING OR SPECIFICATION)

DATE COMPLETED 04/20/2006 (DATE LOT WAS COMPLETED)

DATE INSPECTED 05/01/2006 (DATE LOT PRESENTED TO DCM QAR FOR INSPECTION/SAMPLES)

* LINE

* ZONE WEIGHT

CHARGE WEIGHT .000260 LB (MEASURING UNIT IN POUNDS)

* INDEX OF POWDER

* MAX PACK DEPTH (US)

* MAX PACK DEPTH (METRIC)

* PROD PACK DEPTH

EXPLOSIVE WT PKG .1040 LB (N.E.W. FOR ALL UNITS CONTAINED IN OUTER MAX PACK)

TEST SAMP 47 (TOTAL # OF LAT SAMPLES INCLUDING RETAINS; SEE NOTES KTR TESTED)

TS-SENT-TO-PG 4 (TEST ACTIVITY CODE WHERE LATS ARE SENT TO; PULL DOWN SCREEN)

TS-DATE-SHIPPED 06/29/2006 (MM/DD/YYYY)

TS-MODE-SHIPPED FEDEX (METHOD OF SHIPMENT)

DOT NOMENCLATURE CARTRIDGES, POWER DEVICE (UN PROPER SHIPPING NAME, SECT D)

HAZARD CLASS 1.4C (HAZ CLASS & COMPATIBILITY CODE PER SECTION D OF CONTRACT)

GOV'T QA ACTIVITY 039 (DCM ACTIVITY CODE FOUND IN WARP MANUAL PGs 57-58) DISPOSITION PA (PA - PENDING ACCEPTANCE {LATs}; AC – ACCEPTED LOT (APPROVAL LTR)

GOV'T INSPECTOR JOE G. DCAS

DATE SIGNED 06/25/2006 (DATE SIGNED BY GOV’T INSPECTOR)

COMPONENTS ****************************************** (LIST ALL COMPONENTS, NOT JUST EXPLOSIVES, INCLUDING EXPLOSIVE SUB-ASSEMBLY COMPONENTGS WHEN NOT COVERED BY A SEPARATE

AMMUNITION DATA CARD)

COMPONENT DRAWING NO. MANUFACTURER DATE LOT NUMBER QTY

(INCLUDE DWG REV, SHOW N/A FOR NO REV) (OF COMPONENT)

O-RING MS3324-8 A HANCOCK, INC 1205 23026 2775

ADHESIVE MMM-A-134B 3M SEALANTS 0405 36669 AR

PRIMER MIX 878 2240790C PQP, INC 0305 PQP123 2.5 LB

PROPELLANT 855AS222A GFM 1205 HES 5806 350 GM

CLOSURE DISC 875AS444A ALVIN, CORP 0805 33217 2775

FIRING PIN 2513655B SHARP, INC 0605 35889 2775

SPRING 5558990B SLINKY SPRINGS 0705 77899 2775

SHEAR PIN 838AS444B REIMER PINS 0705 99787 2775

SET SCREW 2246777B SCREWS UNLIMITED 0505 06778 2775

RING, LOCK 777AS444A BOYD RINGS, INC 0605 87877 2775

CTG BODY 777AS888C KRIKSTAN BODIES 1105 55676 2775

PRIMER 877AS999B GFM 0605 OLIN 593 2775

REMARKS **********************************(LIST USEFUL LOT INFORMATION NOT ACCOUNTED FOR IN

OTHER ADC FIELDS)

1. (LOT S/N RANGE: 001 THRU 2775)

2. LAT qty x-ea S/N’s: 002, 022, 034, 145, 179, 222, 345, 478, 666, 788, 998, 1005, 1035, 1165, 1245, 1356, 1599, 1655, 1788, 1889, 2190, 2001, 2069, 2100, 2267, 2345, 2544, 2699, 2701, and 2722.

3. Retain S/N’s: 003,033 and 200.

4. REJECT S/N’s: 175, 435, 1050, and 2233.

NOTE: AN ACCURATE AND UNDERSTANDABLE ACCOUNTING OF ENTIRE LOT BY SERIAL NUMBER

IS REQUIRED. TERMS SUCH AS “ATTRITION”, “EXCESS” OR “RESIDUAL” CAUSE CONFUSION AND SHALL NOT BE USED. TENSILE TEST SPECIMENS FOR LINEAR PRODUCTS SHALL BE IDENTIFIED

BY SERIAL NUMBER.

5. KTR ITEM P/N CORRESPONDS TO GOVT DWG 951AS111 (ONLY IF GOVT DWG # IS NOT USED

IN ABOVE SECTION)

6. LOT REWORKED FOR SHEAR PINS PER APPROVED REWORK PROCEDURE # PQP RW06-

001. WAIVER AND DEVIATION DATA ******** (LIST ALL INDIVIDUALLY, DO NOT GROUP; LIST

APPROVAL # AND BRIEF DESCRIPTION)

7. RFW WAIVER # FY06-W111; SIX UNITS FAILED PMAX REQUIREMENT OF 3100 PSI WITH WORST

CASE BEING 2979 PSI.

8. RFD DEVIATION FY06-D115; ALLOWS THE USE OF ALTERNATE MATERIAL (BRASS) IN PLACE

OF CHIPBOARD FOR THE CARTRIDGE WAD.

** ADDITIONAL AMMO DATA CARD HELPFUL HINTS/REFERENCE NOTES **

THE ABOVE IS MADE UP OF DIFFERENT LOT SCENARIOS TO PROVIDE EXAMPLES. THIS IS

MEANT TO BE USED AS A GUIDE TO HELP REMOVE FRUSTRATION AND PROVIDE SOME

CONSISTENCY FOR THE INPUTTERS AND THE REVIEWERS. IT WILL NOT ADDRESS ALL

SITUATIONS. FOR MORE

DETAILS GO TO THE WORLDWIDE AMMUNITION-data REPOSITORY PROGRAM (WARP) USER’S MANUAL

ON THE WARP WEBSITE BELOW. IF STILL UNSURE, SEEK ADDITIONAL GUIDANCE FROM TECHNICAL

ACTIVITY IN CONTRACT (KT). (NOTE: TO ACCESS WARP, YOU MUST HAVE A CAC OR PURCHASE

AN ECA THROUGH A GOVERNMENT APPROVED VENDOR SUCH AS IdenTrust

(http://identrust.com/warp/)).

WARP WEBSITE – https://mhpwarp.redstone.army.mil http://identrust.com/warp/))

AMMUNITION DATA CARD (ADC) SERVES AS A “BIRTH CERTIFICATE” FOR LOT – GIVES ALL

DETAILS OF LOT MANUFACTURE AT FINGERTIPS. USED FOR MALFUNCTION INVESTIGATION AND

AMMUNITION RECLASSIFICATION. INCORRECT OR INCOMPLETE INFORMATION ON ADC’S COMES

DOWN TO A SAFETY ISSUE.

AMMUNITION DATA CARD IS NOT INTENDED TO INDENTIFY SPECIFIC SHIPMENTS WITHIN A GIVEN

LOT.

* DENOTES FIELDS NOT REQUIRED FOR CADs/CTGs

PACKING: THERE ARE 2 LINES AVAILABLE SO GIVE SPECIFIC DETAILS OF HOW ITEMS WERE

PACKED INCLUDING INNER, INTERMEDIATE (if required) AND OUTER PACKAGING.

INCLUDE NUMBER OF UNITS IN EACH TYPE OF PACKAGING CONTAINER FOR THE

NORMAL MAXIMUM PACKAGING CONFIGURATION. INCLUDE SPI OR PACKAGING DRAWING

NUMBER(s).

ABBREVIATIONS: LB = POUNDS, GR = GRAINS, GM = GRAMS, AR = AS REQUIRED

IF TESTED AT CONTRACTOR’S FACILITY – PUT TOTAL NUMBER (INCLUDING RETAINS) OF

SAMPLES IN THE “TEST SAMP” FIELD AS STATED IN THE CONTRACT AND THEN UNDER “REMARKS”

PUT # OF RETAINS SHIPPED TO NSWC IHD; FOR EXAMPLE: 45 UNITS TESTED AT CONTRACTOR’S

FACILITY AND 2 RETAINS SHIPPED TO NSWC INDIAN HEAD ON 2/19/2006. FOR “TS-SENT-TO-

PG” USE ALPHA “O” WHICH DESIGNATES “ON-SITE FACILITY”(PRIVATE CONTRACTOR ONLY).

DIFFERENCE BETWEEN THE LAT AND PRODUCTION LOT ADC - THE ONLY DIFFERENCES BETWEEN

THE LAT AND PRODUCTION LOT ADC SHOULD BE THE DISPOSITION LINE FROM “PA” TO “AC”

UNLESS THERE ARE REJECTED SERIAL NUMBERS OR WAIVERS/DEVIATIONS THAT NEEDS TO BE

ADDED IN THE APPROPRIATE SECTIONS.

EXPLOSIVE SUB-COMPONENTS- CARTRIDGES (CTGs), INITIATORS, ETC. NOT MANUFACTURED BY

THE END ITEM MANUFACTURER SHALL HAVE THEIR OWN ADC. USE END ITEM NSN & DODIC.

THERE ARE TWO OPTIONS FOR SUBCONTRACTED EXPLOSIVE ITEMS:

1. IF THERE IS A FLOW DOWN REQUIREMENT FROM THE PRIME TO PREPARE DATA CARDS AND THE

SUBCONTRACTOR USES THE WARP PROGRAM – THE SUBCONTRACTOR WOULD USE THE PURCHASE

ORDER NUMBER FROM THE PRIME CONTRACTOR IN THE PURCHASE ORDER NUMBER FIELD AND WOULD

ENTER THE PRIME CONTRACT NUMBER IN THE CONTRACT/ORDER NUMBER FIELD. GARA/QAR FOR

THE SUBCONTRACT WOULD NOT HAVE OVERSIGHT OF THE PRIME CONTRACT NUMBER.

2. IF THE SUBCONTRACTOR IS NOT ABLE TO USE THE WARP SYSTEM FOR THE DATA CARDS THEN

THEY WOULD PROVIDE THE PRIME CONTRACTOR WITH THE INFORMATION AND THE PRIME WOULD

ENTER THE INFORMATION ON THEIR DATA CARD.

Page 1 of 3 DD FORM 1694, MAY 2015 PREVIOUS EDITION IS OBSOLETE

DISTRIBUTION STATEMENT:

REQUEST FOR VARIANCE

(RFV)

1. DATE PREPARED:

(DD-Mon-YYYY)

2. RFV NUMBER:

3. PROCURING ACTIVITY NO. (PAN):

OMB No.

0704-0188

The public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of the collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100 (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THIS ADDRESS. RETURN COMPLETED FORM TO THE ACQUIRER ISSUING CONTRACTING OFFICER FOR THE CONTRACT/PROCURING ACTIVITY NUMBER LISTED IN ITEM 23 OF THIS FORM.

4. TITLE OF VARIANCE:

5. VARIANCE PRE OR POST-PRODUCTION:

Pre-Production Post-Production

6. BASELINE AFFECTED:

Functional Allocated Product

7. SYSTEM

INFORMATION

a. MODEL/TYPE DESIGNATION: b. SYSTEM/CONFIG. ITEM NOMENCLATURE: c. END ITEM CAGE CODE:

8. AFFECTED ITEM NOMENCLATURE: 9. PART NUMBER(S) OF AFFECTED ITEM(S):

10a. OTHER EXTERNAL SYSTEM AFFECTED?:

Yes No

b. IF BLOCK 10a IS YES, LIST OTHER SYSTEMS OR CONFIGURATION ITEMS AFFECTED:

11. IDENTIFICATION

OF DEFECT

a. VARIANCE CLASSIFICATION:

Critical Major Minor

b. DEFECT NO.: c. DOCUMENT DEFINING DEFECT NO./CLASS:

12. DESCRIPTION OF VARIANCE:

13. NEED FOR VARIANCE:

14. CORRECTIVE ACTION TAKEN:

15. EFFECT ON PERFORMANCE, FUNCTION, RELIABILITY, DURABILITY, INTEGRATED LOGISTICS SUPPORT, INTERFACE OR SOFTWARE:

16. RECURRENCE a. RECURRING VARIANCE?:

Yes No

b. IF BLOCK 16a IS YES, PROVIDE RATIONALE:

17. EFFECTIVITY: (Quantity Affected, Lot Numbers Affected, Serial Numbers, Dates)

18. PER UNIT COST IMPACT: 19. TOTAL COST IMPACT: 20. EFFECT ON SCHEDULE IF APPROVED/DISAPPROVED:

21. CONTRACT

INFORMATION

a. SUPPLIER: b. CONTRACT NO. AND LINE ITEM:

22. CONTRACTING

OFFICER

a. NAME: b. TELEPHONE: c. E-MAIL:

23. ORIGINATING

ACTIVITY

a. NAME:

c. TELEPHONE:

b. ADDRESS: (Street, City, State, Zip Code)

e. E-MAIL:d. CAGE CODE:

24a. SUBMITTING AUTHORITY: b. NAME AND TITLE: c. SIGNATURE:

BELOW TO BE COMPLETED BY THE APPROVING ACTIVITY

25a. RECOMMENDATION: Approval Approval with Modification Disapproval

b. NAME AND TITLE: c. SIGNATURE: d. DATE: (DD-Mon-YYYY)

26a. DISPOSITION: (Configuration Approval Authority) Approved Approved with Modification Disapproved

b. NAME AND TITLE: c. SIGNATURE: d. DATE: (DD-Mon-YYYY) elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line melina.andino-rivera Typewritten Text RFV Form 1694 Additional Guidance Revision NA dated 03/23/17

Page 2 of 3 DD FORM 1694 INSTRUCTIONS, MAY 2015

INSTRUCTIONS FOR PREPARATION OF

REQUEST FOR VARIANCE UTILIZING DD FORM 1694

GENERAL

SCOPE. This instruction establishes uniform requirements for the preparation of the DD Form 1694, “Request for Variance (RFV)".

APPLICATION. The provisions of this instruction apply whenever DD Form 1694 is utilized to request a variance.

APPLICABLE DOCUMENTS. DI-SESS-80640

GENERAL REQUIREMENTS. Use of DD Form 1694. Prepare and submit DD Form 1694, or an Acquirer authorized alternative, to request variances from configuration documentation requirements.

Request for Variance (RFV). This form replaces the previous DD Form 1694 “Request for Deviation/Waiver (RFD/RFW)”.

DETAILED REQUIREMENTS. Detailed Instructions for completion of the DD Form 1694 are as follows. Confirm each applicable block of DD Form 1694 is filled or marked appropriately in accordance with the instructions provided herein. Failure to complete all applicable fields may result in rejection from the approving authority.

Block 1. Date Prepared. Enter the submittal, preparation or revision date of the RFV prepared in the format DD-Mon-YYYY (e.g., 01- Jan-2014).

Block 2. RFV Number. Enter the RFV unique identifier or tracking indicator, and if required, a revision indicator with RFV identifier.

Block 3. Procuring Activity No. (PAN). To be entered by the procuring activity to provide an internal processing number if required.

Block 4. Title of Variance. Enter a title to describe the variance.

Block 5. Variance Pre or Post-Production. If the RFV is requested prior to manufacture of the item, check “Pre-Production” (e.g. variance approval requested prior to need (pre DD 250); product to be manufactured as nonconforming). If the need for the variance is identified after the item(s) manufacture, check “Post-production” (e.g.

variance approval requested after being produced (post DD 250); product manufactured and found to be nonconforming).

Block 6. Baseline Affected. Enter the affected baseline.

Block 7a-c. System Information. Enter the model or type designation identifier of the Configuration Item (CI) or Computer Software Configuration Item (CSCI) for which variance is being submitted (e.g., M16, Mk48, F22, etc.), System/Configuration item nomenclature (e.g., Rifle, Torpedo, Fighter, etc.), and Supplier end item CAGE Code.

Block 8. Affected Item Nomenclature. Enter the specific item nomenclature of the part/assembly affected by the variance (e.g., bracket assembly).

Block 9. Part Number(s) of Affected Item. Enter the specific part number or type designation/nomenclature, if applicable, of the item containing the defect or nonconformance.

Block 10a. Other External System Affected. Check `Yes' in this field if the variance impacts another system (e.g., interfacing system, training device, and test sets). Check `No' if otherwise.

Block 10b. List Other Systems or Configuration Items Affected. List Other External Systems or Configuration Items Affected. If block 10.a. is checked `Yes', list the other system(s) or Configuration Item(s) (CIs) affected.

Block 11a-c. Identification of Defects. Enter the variance Defect classification, Supplier Defect Number (optional), and the Supplier Document Defining Defect No/Class (optional).

11a. Defect Classification: Enter the classification of the variance based on the impact of the defect:

i. Critical. Use this classification when it is a departure from requirements affecting one or more of the following:

(1) safety

(2) human health

(3) environment, and

(4) security (local program or national).

ii. Major. Use this classification when it is a departure from requirements affecting one or more of the following:

(1) performance or operational limits,

(2) interchangeability, reliability, survivability, maintainability, or durability of the item or its repair parts,

(3) structural strength,

(4) effective use or operation,

(5) weight, moment, center of gravity

(6) appearance,

(7) limits on product use or operation,

(8) temporary use of alternate items, or

(9) when the configuration documentation defining the requirements for the item classifies the departure from the requirement as major.

iii. Minor. Use this classification when it consists of a departure which does not involve any of the factors listed for critical or major or when the configuration documentation defining the requirements for the item classifies the departure from the requirement as minor. Note: Departures from the requirements that do not meet the definition of critical or major and are not classified in any configuration documentation (i.e. unlisted characteristic) are treated as minor.

11b. Defect No. (optional): Enter the Supplier defect number which corresponds with the Variance listing of defect characteristic(s) from which an authorized variance can be released.

11c. Document Defining Defect No./Class (optional): If needed, enter the appropriate title or reference number of the Supplier document that details/lists the defect numbers or identifies the variance classification based on the defect number definition(s).

Block 12. Description of Variance. Enter a description of the variance.

Describe the nature of the proposed departure from the technical requirements of the configuration documentation. Marked drawings or other documents are included to describe and justify approval of the variance. Provide the impact of other systems or configuration items, as required. An RFV addressing Nonconforming Material (NCM) produced by pre-production or post-production includes a request for the material (part) be repaired, use-as-is, or scrapped, and in some cases retrofitted.

Block 13. Need for Variance. Describe the need for the Variance.

Explain why it is not possible to comply with the configuration documentation within the specified delivery schedule. Also, if applicable, explain why a variance is proposed in lieu of a permanent design change.

Block 14. Corrective Action Taken. Describe any action(s) taken to prevent a future recurrence of this variance.

Page 3 of 3 DD FORM 1694 INSTRUCTIONS, MAY 2015

INSTRUCTIONS FOR PREPARATION OF

REQUEST FOR VARIANCE UTILIZING DD FORM 1694

Block 15. Effect on Performance, Function, Reliability, Durability, Integrated Logistics Support, Interface or Software. Describe the effects of the variance on any of the factors listed on Page 2 of DD Form 1692, Engineering Change Proposal (ECP). Describe any effects this variance may have on these factors, contract requirements or configuration documentation. If the variance has no effect on these factors, then provide a statement acknowledging the DD Form 1692 review and identify which factors have no impact.

Block 16a-b. Recurrence. If the same variance has been requested previously, check `Yes' or check `No' otherwise. If Block 16.a. is `Yes', provide justification for the recurrence of this variance and explain why previous corrective actions did not prevent it from recurring.

Block 17. Effectivity. Describe the product effectivity of this variance.

Items affected may be listed by quantity, lot number(s), serial number(s), date(s) produced, or a combination thereof.

Block 18. Per Unit Cost Impact. Enter the per unit cost impact of the variance. Variances accepted Post-Production should result in a reduction in cost; indicate cost reductions by enclosing the value in parentheses.

Block 19. Total Cost Impact. Enter the total cost impact of the affected variance. Variances accepted Post-Production should result in a reduction in cost; indicate cost reductions by enclosing the value in parentheses.

Block 20. Effect on Schedule if Approved/Disapproved. Describe any positive or negative effects on the delivery schedule pending the approval or disapproval of this variance.

Block 21a-b. Contract Information. Enter the Supplier name, contract number, and the line item of the affected item as applicable.

Block 22a-c. Contracting Officer. Enter the name, telephone no., and email of contracting officer for the Acquirer.

Block 23a-e. Originating Activity. Enter the name, address, CAGE Code, email and telephone number of the originating supplier or organization for the RFV.

Block 24a-c. Submitting Authority. Enter the submitting activity, name, title, and signature of the individual authorized to submit the RFV on behalf of the originating activity (may be the same as identified in Block 23.a-e).

Block 25a-d. Recommendation. Enter the name, title, signature and date signed. This block is completed by the activity making a recommendation to the Configuration Approval Authority, as required.

Block 26a-d. Disposition. Enter the name, title, signature and date signed. This block is completed by the Configuration Approval Authority authorized to make the decision on the RFV.

Distribution Statement. Use this block to insert the appropriate Distribution Statement and/or Export Control Warning for this form in accordance with Block 9 of the applicable DD Form 1423, “Contract Data Requirements List” which this document is being delivered against and/or DODI 5230.24, Distribution Statements on Technical Documents.

(Provide enough specific details to support the understanding of the proposed variance.)

Blk13-NfV: Rubber IAW MIL-R-81090 Type I is unavailable. It is requested that the Shorting Cap be made of 6061-T6 Aluminum for this contract IAW the red-lined drawing (attached) (Explain why needed with technical justification.)

Somewhere City, STATE 55555